APAC Centers for Pain Management, Chicago, IL, USA.
Curr Med Res Opin. 2011 Mar;27(3):673-83. doi: 10.1185/03007995.2011.553214. Epub 2011 Feb 7.
Fibromyalgia (FM) is characterized by persistent and widespread pain and often associated with other symptoms and comorbidities. Thus, FM patients seek care from multiple physician specialties. This study compared prescribing patterns, patient-reported outcomes (PROs), healthcare resource use (HRU), and direct costs related to FM in routine clinical practice across physician specialties.
This cross-sectional, observational study recruited 203 FM subjects from 20 community-based physician offices (eight primary care, six rheumatology, three neurology, three psychiatry). Subjects completed questions about pain, other symptoms, quality of life, productivity, treatment effectiveness and satisfaction, and out-of-pocket expenses related to FM; site staff recorded subjects' treatment and HRU based on medical chart review. Results were compared across specialties. Statistical significance was evaluated at the 0.05 level. Annual direct costs associated with FM were calculated in 2009 US dollars.
Subject demographic and clinical characteristics were not significantly different across physician specialties, except psychiatry subjects had the highest mean number of co-morbid conditions; p < 0.001. PROs were similar across physician specialties except fatigue; neurology subjects reported the highest levels. There were no significant differences in subject-reported outcomes of medication effectiveness (p = 0.782) and medication satisfaction (p = 0.338) for FM. Psychiatry subjects had more FM-related physician visits compared to other specialties (p = 0.013) and a higher proportion received diagnostic tests related to FM (p = 0.013). The mean (SD) number of FM prescription medications prescribed per subject was highest in the primary care and lowest in the neurology group; p = 0.024. The proportion of hypnotic (p = 0.001), muscle relaxant (p = 0.005), anxiolytic (p = 0.005), anti-epileptic (p = 0.007), and other medications (p = 0.044) prescribed for FM were significantly different across specialties. Overall direct medical costs did not differ significantly (p = 0.284) across specialties.
Patient characteristics were similar across specialties, except with regards to comorbidity burden. This study noted significant differences among physician specialties in HRU and treatment patterns among medications, diagnostics, and outpatient visits. Consistent with other studies, this study did not identify a dominant strategy for FM management across physician specialties as overall per patient medical costs and subject-reported treatment satisfaction were similar. Future research to better characterize differences among physician specialties in FM management, as well as the reasons for these differences, would be useful.
纤维肌痛（FM）的特征是持续性广泛疼痛，常伴有其他症状和合并症。因此，FM 患者会向多个医学专业医生寻求治疗。本研究比较了在常规临床实践中，不同医学专业的 FM 患者的处方模式、患者报告的结局（PRO）、医疗资源使用（HRU）和与 FM 相关的直接费用。
这是一项横断面、观察性研究，在 20 个社区医生办公室（8 个初级保健、6 个风湿病学、3 个神经病学、3 个精神病学）招募了 203 名 FM 患者。患者完成了有关疼痛、其他症状、生活质量、生产力、治疗效果和满意度以及与 FM 相关的自付费用的问题；根据病历审查，现场工作人员记录了患者的治疗和 HRU。结果在专业之间进行了比较。在 0.05 水平评估统计学意义。用 2009 年的美元计算与 FM 相关的年度直接费用。
除精神病学患者的合并症数量最高（p<0.001）外，患者的人口统计学和临床特征在不同医学专业之间没有显著差异。PRO 在医学专业之间相似，除了疲劳；神经病学患者报告的水平最高。FM 药物有效性（p=0.782）和药物满意度（p=0.338）方面，患者报告的结果没有显著差异。与其他专业相比，精神病学患者的 FM 相关就诊次数更多（p=0.013），接受与 FM 相关的诊断性检查的比例也更高（p=0.013）。每个患者处方的 FM 处方药的平均（SD）数量在初级保健中最高，在神经病学组中最低；p=0.024。处方用于 FM 的催眠药（p=0.001）、肌肉松弛剂（p=0.005）、抗焦虑药（p=0.005）、抗癫痫药（p=0.007）和其他药物（p=0.044）的比例在不同专业之间存在显著差异。总体而言，医疗费用在不同专业之间没有显著差异（p=0.284）。
患者特征在专业之间相似，除了合并症负担。本研究注意到，在 HRU 以及药物、诊断和门诊治疗模式方面，不同医学专业之间存在显著差异。与其他研究一致，本研究没有发现 FM 管理的主导策略在不同医学专业之间存在差异，因为每个患者的总体医疗费用和患者报告的治疗满意度相似。未来的研究将有助于更好地描述 FM 管理在不同医学专业之间的差异，以及这些差异的原因。
